RLE Self-Test Call Today Contact Us "*" indicates required fields What is your age group?* 18-42 42-49 50-65 65+ Without my glasses and contacts... (check all that apply)* Farsightedness: Difficulty reading and seeing things up close Nearsightedness: Difficulty driving and seeing things far away Astigmatism: Distorted vision and cannot see very well in general What do you usually wear? (check all that apply)* Prescription Glasses Contacts Reading Glasses None of Them Do you have any of the following? (check all that apply)* Rheumatoid Arthritis Multiple Sclerosis Prior eye injury Keratoconus Diabetic Retinopathy None of above Pregnant or nursing Lupus Do you have cataracts or have you had cataract surgery in the past?* Yes No Have you had LASIK or PRK in the past?* Yes No I would like to see well at a distance without relying on glasses and contact lenses.* 1 2 3 4 5 Rate this statement on a scale of 1 to 5 with 1 being the lowest. Are the following statements important to you?I would like to see well at a distance without relying on glasses and contact lenses.* Yes No I'm not sure I would like to see well up close without relying on glasses and contact lenses.* Yes No I'm not sure It is important to me to see well at night after cataract surgery.* Yes No I'm not sure Would you like to speak with one of our specialists?* I'm ready to book my consultation! Yes, please call me to discuss my options. I'm not ready yet. Ready to Ditch the Readers and Glasses? Thank you for completing the RLE Self-Test. Based on your responses, you may be a great candidate for Refractive Lens Exchange — a long-term solution for freedom from glasses, especially for those over 40 experiencing vision changes.Book Your Refractive Evaluation The best way to know for sure is to come in for a comprehensive refractive evaluation with our experienced surgeons. We’ll review your eye health, discuss your goals, and personalize a plan to help you see clearly — without depending on glasses or contacts. Our team will contact you to set up an evaluation.First / Last Name* First Last Phone Number*Email Address* Date of Birth* MM slash DD slash YYYY Consent* Do you consent to receive text communications from Brooks Eye Associates*Consent* Do you consent to receive email communications from Brooks Eye Associates* Δ
